One in five adults with private insurance was denied coverage for themselves or a family member for care their doctors recommended, according to a Commonwealth Fund report published on Thursday.
Among more than 4,500 adults with private insurance who responded to a healthcare affordability survey, 21% reported a coverage denial in 2025. Of those receiving denials, 13% received prior authorization denials, 8% received claim denials, and 1% received both.
"When delivering healthcare, the goal is to get patients what they need, when they need it -- and decisions about care should be guided by the clinicians and care teams who understand their patients best," said Joseph Betancourt, MD, MPH, president of the Commonwealth Fund, in a press release.
Betancourt, an associate professor of medicine at Harvard Medical School in Boston, noted that he recently recommended an endoscopy for a patient experiencing gastrointestinal problems. A prior authorization request for the procedure was denied twice. After some discussion with the insurer, the procedure was covered -- but with a significant copay.
"For the 5 days that we're waiting for pathology, you're sitting on pins and needles, because you know that denial potentially can cost your patient their life," he said.
